Prevalence of sesamoid bones in the interphalangeal joint of the thumb and fingers: A Radiographic Study

The prevalence of sesamoid bones in the hands has been reported in some previous articles. Most of them, however, have reported sesamoid bones of the metacarpophalangeal joint of the hand and of the interphalangeal (IP) joint of the thumb. The present study investigates the prevalence of sesamoid bones of the IP joint of the thumb and fingers. A retrospective review of radiologic views of the IP joints in the thumb or fingers was performed, including a total of 650 patients (1,096 thumbs or fingers). Sesamoid bones were found in the IP joint of the thumb at 67% (212 of 318), while the index, middle, ring, little fingers had sesamoid bones in the proximal interphlangeal (PIP) joint at 0% (0 of 172), 0.4% (1 of 244), 0.5% (1 of 183), and 1% (2 of 179), respectively. None of the four fingers had sesamoid bones in the distal IP joint. Previous articles have described the similar prevalence to the present study, of sesamoid bones of the IP joint of the thumb, while some others reported the different prevalence. About the PIP joint, no previous articles have found a sesamoid bone. Because the lateral X‐ray view is more accurate and suitable to evaluate sesamoid bones, we used the lateral one for the present study. The knowledge that sesamoid bones occurs at these rates in the thumb IP joint and finger PIP joints is helpful to differentiate chip fractures from sesamoid bones near the IP joint, including the PIP joint. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

海水浸泡感染后皮肤软组织缺损修复的差异性观察Δ

[目的]观察海水浸泡感染后人工材料置入皮肤软组织缺损的修复研究。[方法]取狗左右桡骨中段截骨制成开放性皮肤软组织及骨缺损动物模型,随机分成二组,实验组海水浸泡伤口2 h,对照组开放伤口自然暴露2 h,感染后3 d分别给予伤口清创并置入人工骨,每组各12只,创面共24例,并以玻璃纤维石膏绷带固定,术后12周观察各组动物皮肤、软组织愈合及材料移动情况,并行统计学分析。[结果]a:术后12周实验组皮肤及软组织愈合差于对照组,P<0.05,有统计学意义;b:术后12周实验组与对照组材料移动情况无明显差别,P>0.05,无统计学意义。[结论]海水浸泡感染后动物皮肤及软组织愈合差于自然暴露感染动物,海水浸泡与自然暴露材料稳定性一样差。     

Effectiveness of Community Intervention in Improving Bone Health Behaviors in Older Adults

An 8-week, bone-health community program addressed risks/lifestyle changes within the Health Belief Model and Theory of Reasoned Action frameworks in a randomized format (treatment group n = 35; control group n = 34). Median week 1 values for calcium (control, 963 mg; treatment, 1023 mg) and vitamin D (81 IU both groups) were below recommendations, increasing throughout the program for both control (1023 mg calcium, 128 IU vitamin D) and treatment (1005 mg calcium, 122 IU vitamin D) groups. There was limited response to the exercise outcome variables, with many not participating in that section of the program. Psychosocial variables were positive for both control and treatment groups at week 1, with no significant difference at postintervention. Regression analysis indicated that those with a positive attitude about calcium intake and belief that they could choose calcium-fortified foods were more likely to have higher calcium intake. Intention to exercise was modified by peer and family support. Community-based programs can translate and use clinical trial key topics and outcomes, but participation bias makes impact results difficult to interpret the effectiveness of the program.     

三酰甘油/高密度脂蛋白胆固醇比值与糖尿病并发症的关系研究进展

糖尿病作为重要公共健康问题，严重影响人们生活质量，给社会经济带来严重负担，特别是糖尿病并发症。血脂异常在糖尿病人群中患病率逐年上升，脂代谢异常在糖尿病并发症的发生及发展中占有重要的地位，逐渐被人们重视，尤其是三酰甘油（TG）/高密度脂蛋白胆固醇（HDL-C）比值，是目前临床研究热点问题，根据目前研究发现，TG/HDL-C比值在糖尿病并发症的发生、发展中起到重要作用。本文就TG/HDL-C比值与糖尿病并发症的关系情况做一综述，发现TG/HDL-C比值与糖尿病并发症有关，与微血管并发症及大血管并发症均有联系，但是，仅从目前研究中，TG/HDL-L比值与糖尿病具体并发症的切值没有统一的标准，还需进一步研究。     

Exploring Body Art Trends

‘Best of the Literature’ presents summaries of sports medicine-related articles culled from more than 30 medical journals. Experts comment on what the new findings add to current medical thinking and on the implications for practice.     

Primary,large extra‐axial chordoma in proximal tibia: a rare case report with literature review and diagnostic implications

Primary extra‐axial chordomas have been rarely documented, especially in the appendicular bones. Until now, nine such cases, objectively confirmed with positive brachyury immunostaining, have been reported. A 42‐year‐old male presented with pain in his right tibial tuberosity (shin) of 2–3 years duration without any associated swelling. He denied complaints related to any other lesion elsewhere in his body. Plain radiograph of his lower limbs revealed a large, eccentric, well‐defined, lytic lesion containing internal septae with a narrow zone of transition and a sclerotic medullary border in the upper metaphysis of his right tibia, associated with a pathological fracture. There was no other lesion identified in his spine on radiographic imaging. Biopsy sections revealed a tumour composed of polygonal cells with moderate to abundant eosinophilic to vacuolated/‘bubbly’ cytoplasm (physaliphorous cells) arranged in lobules within a conspicuous myxoid matrix. By immunohistochemistry, tumour cells were diffusely positive for pan cytokeratin (AE1/AE3), epithelial membrane antigen (EMA), CK19, S100P, meso (HBME1) and Brachyury/T. Diagnosis of an a primary extra‐axial chordoma was finally rendered. Subsequently, the patient underwent bone grafting from his iliac crest. The present case constitutes as the 11th documented case of an extra‐axial, intraosseous chordoma and the 10th such case occurring in the appendicular bones. Literature review of similar cases; their diagnostic mimics along with diagnostic and therapeutic implications of such cases are discussed herewith.     

Case of toxic epidermal necrolysis occurring after bone marrow transplantation accompanied by engraftment failure

Toxic epidermal necrolysis (TEN) is a rare condition, causing life‐threatening adverse cutaneous reactions. TEN occurrence after bone marrow transplantation (BMT) is a well‐known phenomenon; however, to date, only a few cases have been reported in the published work. Here, we describe the case of a 53‐year‐old woman who experienced TEN after undergoing allogenic BMT for malignant lymphoma. Skin erosion spread across a maximum of 70% of the body surface area and severe mucosal lesions developed. Steroid pulse therapy, plasma apheresis and immunoglobulin therapy were administrated, which resulted in the complete resolution of TEN. However, she developed hemophagocytic lymphohistiocytosis and died 38 days after BMT, owing to rupture of the lower digestive tract complicated by multi‐organ failure. In our case, engraftment failure occurred, and the peripheral white blood cell count was less than 100/μL during the TEN course, suggesting that the presence of only a few immune cells could cause TEN. Our findings showed that high mortality rates and widespread skin erosion could be regarded as the most important characteristics of TEN occurring after BMT.